Dr. Chapa’s OBGYN Clinical Pearls

The “ideal“ interpregnancy interval depends on the outcome of the immediate, prior pregnancy. For example, the recommended interpregnancy interval following a 1st trimester miscarriage is different compared to a live, term birth. But what about the interpregnancy interval after a stillbirth? Are the recommendations the same? In this podcast will review updated data from 2019 regarding interpregnancy interval following stillbirth. The reference for this podcast summary is Regan AK, et al; Lancet, April 2019.

You find that there is a medical indication for a cesarean birth- yet the patient refuses! What are your next steps? Should you seek a court order to intervene? “Informed refusal” encompasses a complex, multifaceted, ethical dilemma. In this session, we will review some clear guidelines from the American Academy of Pediatrics, the ACOG, and the AMA regarding the management of this difficult situation.

No! Julius Caesar was not born by cesarean birth. What does a pig-gelder in 1500 have to do with CS History? From Jacob Nufer to Munroe Kerr, we will walk down the path of the cesarean’s incredible history.

Medicine: it’s an incredibly rewarding profession. The opportunity and ability to comfort and heal the sick is an absolute privilege. BUT...if you are not careful, that wonderful of all professions can consume you, and may devour you. Two theories have been proposed to explain this: Burnout, and Moral Injury. But are these 2 separate conditions? How does the issue of mindset (fixed or growth) apply? In the session, we will review the latest (as of December 2019) on this ever evolving issue.

In December 2019, the ACOG will release committee opinion 794 covering quantitative blood loss in obstetrics. Does QBL use ALONE improve clinical outcomes? The answer may surprise you! Nonetheless, there is great value in utilizing obstetric hemorrhage toolkits/bundles such as the California Maternal Quality Care collaborative strategy. In the session, we will review the use of QBL in practice in why having it as part of a larger toolkit helps reduce maternal morbidity and mortality.

Exploring lactational mastitis and abscess management, including breast milk culture collection, antibiotic therapy, and complications like abscess identification and drainage. Learn about the Academy of Breastfeeding Medicine's treatment protocol and the importance of maintaining breastfeeding post-treatment for optimal recovery.

Obesity is a known modifiable risk factor for complications of pregnancy- both antepartum and intrapartum. Data has confirmed a direct link/risk of stillbirth with obesity. In this session, we will review the data on this link as well as the effect of gestational age on the risk of stillbirth. We will also briefly review the ACOG practice bulletin on gestational diabetes and how this may relate to obesity’s risk of stillbirth. This podcast will also summarize the (conflicting) data on elective induction of labor at term as an attempt to reduce the risk of stillbirth in the obese population.

Periviable birth is defined as delivery occurring from 20 0/7 weeks to 25 6/7 weeks of gestation. When is the earliest time to consider antenatal steroids for fetal lung maturation, and what about magnesium sulfate for neuroprotection? When should tocolytics be utilized? And when is the earliest just stational age to consider a C-section for fetal benefit? In this session, we will cover these questions according to the ACOG consensus statement #6.

Exploring the potential health impacts of MTHFR variants, this podcast delves into the differences between common variants and true mutations. It discusses the rarity of actual risks associated with these variants and emphasizes the importance of early detection. The podcast also explores the effectiveness of folate supplementation in managing elevated homocysteine levels and highlights the limited clinical relevance of testing for MTHFR variants in certain health conditions.